LimitationsExamples of Criticism

The new classification (1999) has too many sub-classifications (hierarchy); for example, pregnancy gingivitis is found in I A 2a 3a/b! In addition, it would appear to be totally impractical that the most commonly occurring disease entities are not identified with simple abbreviations, except for CP, AP, NUG/NUP.

Possibly the most important chapter in this Atlas, “Oral manifestations of HIV-infection and AIDS “ (p. 142) is not even listed in the new classification, even though this severe immunodeficiency not only manifests as necrotizing ulcerative gingivitis/periodontitis (NUG/NUP), but also as a specific “linear gingival erythema,” and a long list of opportunistic secondary infections in the oral mucosa and periodontium (bacterial, viral and fungal infections, as well as tumors such as the Kaposi sarcoma, p. 146).

“Classical gingival recession,” which has become more and more common in industrialized nations in recent years (p. 155), is classified under VIIIB1a, “mucogingival deformations and conditions.” Any “soft tissue recession” usually occurs only after some form of osseous dehiscence. Whether this “condition” should be classified as a disease or only as a morphologic variation of the healthy periodontium is really irrelevant for a dental hygienist (improper oral hygiene, functional dysfunction).

Each dental hygienist and dentist must come to grips with the fact that the patient is not interested only in oral health but also, more and more, esthetic problems (gingival recession, “long teeth”), which can only be addressed through mucogingival/plastic surgery.

In the most recent classification, entire disease entities are not represented (infectious diseases—HIV/AIDS), or are inadequately represented (gingival recession), and some “conditions” such as pericoronal abscess (VI C) find themselves on the highest level.

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